本文選題：醫(yī)養(yǎng)理念 + 城市社區(qū)�。� 參考：《浙江大學》2015年博士論文

【摘要】：在人口老齡化進程加快并深度發(fā)展的大背景下,高齡化和失能化趨勢顯著,而“421”倒金字塔家庭結構的大量出現(xiàn),又衍生出家庭空巢化、小型化等現(xiàn)實問題。老年人口嚴重的“四化疊加”現(xiàn)象,對傳統(tǒng)養(yǎng)老模式提出巨大挑戰(zhàn)。單純的家庭養(yǎng)老模式已難以為繼,必須推進社會化養(yǎng)老,支撐完善養(yǎng)老保障體系。但考慮到社會養(yǎng)老服務供給不足、相關資源配置不均、經(jīng)濟發(fā)展水平有限以及傳統(tǒng)孝道文化深入人心等現(xiàn)實國情,若在我國實行完全社會化養(yǎng)老也是不切實際的,這就需要發(fā)展多元養(yǎng)老模式,發(fā)揮各自優(yōu)勢和潛能,在原有基礎平臺上加以優(yōu)化和調整。 本文基于對我國養(yǎng)老服務環(huán)境的發(fā)展和研究現(xiàn)狀的分析以及對國外養(yǎng)老服務體系建設經(jīng)驗的總結,闡述了以醫(yī)養(yǎng)結合為導向的研究視角、目的、意義和框架等基礎平臺問題。其次,對國內外養(yǎng)老設施的演變特征、養(yǎng)老意識形態(tài)與需求、物質形態(tài)與干預進行了解讀,結合相關學科的理論支撐,探討了養(yǎng)老設施“醫(yī)養(yǎng)”模式發(fā)展的可行性。接下來,在類型學理論方法的指導下,通過文獻調查、實地調研和訪談的基礎研究,由表及里,提煉出目前我國醫(yī)養(yǎng)設施發(fā)展的雛形,并在此基礎上進行歸納整合與分類,進而確立本研究的區(qū)域范疇——城市社區(qū)。實現(xiàn)從問題到方法的轉化。隨后,通過前期深入的文獻調查和案例研究,參考老年綜合評估和養(yǎng)老服務評估的評價機制,在定性判斷的基礎上抽取適老化設施營建的影響要素,形成較為系統(tǒng)的醫(yī)養(yǎng)體系數(shù)據(jù)庫。通過權重分析的量化研究進而驗證和調整,建構“醫(yī)養(yǎng)”體系模型。以合理化、規(guī)范化的政策體系為導向,以“整體統(tǒng)一、局部靈活”的方法為原則,針對適老化設施運營的保障政策、社區(qū)內的規(guī)劃布局以及建筑整體和各單元空間的深化設計三個層面提出相應的營建策略和方法,形成多層次、多元化的服務體系,從而實現(xiàn)由理論探討至實踐操作的轉變。以期研究成果對今后實踐提供一定參考依據(jù)。 本文力圖以一種開放和融合的方式創(chuàng)新性轉變“居家養(yǎng)老和設施養(yǎng)老”其內涵,通過對社區(qū)居家老人提供健康管理、上門服務及技術支持,將狹義的“居家”轉變?yōu)樾滦蝿�、新理念下的“養(yǎng)老床位”,提出以“適老化設施”為核心,向社區(qū)全面輻射的養(yǎng)老服務體系。從宏觀層面建立醫(yī)養(yǎng)保障政策和運營管理體系,從中觀層面完善多元復合型適老化設施的規(guī)劃布局,從微觀層面制定醫(yī)養(yǎng)設施的功能需求和建設目標。以此為平臺,進而提出城市社區(qū)新型養(yǎng)老模式下的發(fā)展對策與方法。本文尚有諸多不足,有待今后進一步深入研究,但本文的根本目的在于開拓醫(yī)養(yǎng)理念下的新型養(yǎng)老模式,引發(fā)對我國老齡化問題的思考與探索。
[Abstract]:Under the background of accelerated and deep development of population aging process, the trend of aging and disability is obvious, while the emergence of "421" inverted pyramid family structure has given rise to practical problems such as family empty nest and miniaturization.The phenomenon of "four ways superposition" in the elderly population poses a great challenge to the traditional old-age model.The simple family pension model has been difficult to continue, we must promote the socialized pension, support and improve the pension security system.However, considering the insufficient supply of social services for the aged, the uneven allocation of related resources, the limited level of economic development and the fact that traditional filial piety culture is deeply rooted in the hearts of the people, it is impractical to implement a completely socialized old-age pension system in our country.This requires the development of multiple pension model, play to their respective advantages and potential, in the original basic platform to optimize and adjust.Based on the analysis of the development and research status of the pension service environment in China and the summary of the experience of the construction of the pension service system in foreign countries, this paper expounds the basic platform problems, such as the perspective, purpose, significance and framework of the research guided by the combination of medicine and support.Secondly, it interprets the evolvement characteristics, the ideology and demand, the material form and the intervention of the old-age facilities at home and abroad, and discusses the feasibility of the development of the "medical care" mode of the old-age facilities combined with the theoretical support of related disciplines.Then, under the guidance of typology theory and method, through literature investigation, field investigation and basic research of interview, from the surface to the inside, extract the embryonic form of the development of medical and nursing facilities in our country, and on this basis, summarize, integrate and classify.And then establish the regional category of this study-urban community.Realize the transformation from problem to method.Then, through the previous in-depth literature investigation and case study, referring to the evaluation mechanism of the comprehensive assessment of the aged and the assessment of the old-age service, the influence factors of the construction of the suitable aging facilities are extracted on the basis of qualitative judgment.To form a more systematic database of medical and nursing system.Through the quantitative study of weight analysis to verify and adjust, the system model of "medical nourishment" is constructed.Guided by a rational and standardized policy system, and based on the principle of "unity as a whole, partial flexibility", and in view of the safeguard policies for the operation of aging facilities,The planning and layout of the community, as well as the deepening design of the whole building and each unit space, put forward the corresponding construction strategies and methods to form a multi-level and diversified service system, so as to realize the transformation from theoretical discussion to practical operation.With a view to the research results for the future practice to provide a certain reference basis.This paper tries to change the connotation of "home old-age care and facility old-age care" in an open and integrated way. By providing health management, home service and technical support to the elderly living in the community, the narrow sense of "home" is transformed into a new situation.Under the new concept of "old-age bed", the old-age service system with "suitable aging facilities" as the core and a comprehensive radiation to the community is put forward.The policy and management system of medical maintenance security should be established from the macro level, the planning and layout of the multi-element compound suitable aging facilities should be perfected from the meso level, and the functional requirements and construction objectives of medical and nursing facilities should be formulated from the micro level.Taking this as the platform, this paper puts forward the development countermeasures and methods under the new pension model of urban community.There are still many deficiencies in this paper, which need to be further studied in the future, but the fundamental purpose of this paper is to develop a new pattern of old-age support under the concept of medical care, which will lead to the thinking and exploration of the aging problem in China.
【學位授予單位】：浙江大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：TU984.12

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